Sexual Politics

Public Parts

IN AN IDEAL WORLD, Alec Esquivel's ovaries wouldn't make headlines—the details of the transgender law clerk's reproductive organs would be known only to Esquivel and his doctors.

But instead, Esquivel has decided to sacrifice his confidentiality—thrusting his most private parts into the limelight in what appears to be a groundbreaking fight for his right to health care.

Esquivel, an Oregon employee, filed a lawsuit against the state June 21, arguing that a blanket ban on sex-change operations by Oregon's two public employee insurance plans directly violates the state's anti-discrimination laws. Workers shouldn't have to make their medical history a public spectacle just to get the state to follow its own damn laws, but good on Esquivel for being brave enough to come out and try to hit the state where it hurts the most: its budget.

If the state doesn't agree to change its insurance plans so that every employee is covered equally, officials could be paying for a lot more than the cost of just one sex change: The lawsuit seeks $250,000 in damages.

Just this month, Portland City Council unanimously voted that city insurance must cover sex changes for employees. And now comes a perfect example of what will happen when employers aren't so forward thinking: Workers will sue.

This is likely a first-of-its kind lawsuit. Although transgender prison inmates have successfully sued for coverage of gender-reassignment surgery, Lambda Legal, the LGBT advocacy group on Esquivel's case, says it believes Esquivel is the first transgender state employee to step up and demand equal health care through the courts.

"I'm sharing a lot of stuff about myself that most people would rather not share," says Esquivel. "But sometimes you have to do some education—and having a real face, a real person, makes it easier for people to see that discrimination is a real problem that affects real people."

As the complaint filed in Marion County Court spells out, "Esquivel experienced increased anxiety, distress, and lack of sleep from the incongruity between his felt gender identity, which was now fully expressed outward as male, and his internal female reproductive organs."

Esquivel has been living as a man since 2001, when he moved here to "escape from Nebraska" (as he puts it). He's legally changed his name, his gender, and his birth certificate. For a decade, he has been diagnosed with gender identity disorder, with a sex change listed as the recommended treatment. But the state's insurance providers—Providence and Kaiser—explicitly ban coverage for "all services related to sexual disorders or dysfunctions," including sex changes and hormone therapy.

So since 2001, Esquivel has been paying for the treatment for his diagnosed, mainstream-doctor-recognized disorder, shelling out thousands of dollars for hormones and a breast removal operation. But when the insurance companies refused to cover his hysterectomy this year, Esquivel decided it was time to sue.

Not only does Esquivel not have the cash for the doctor-prescribed procedure (which can cost anywhere from $10,000 to 20,000), but he also wants to change a state insurance policy that clearly violates the state's own anti-discrimination law.

ORS 659A was updated in 2007 to ban discrimination in the "terms, conditions, or privileges of employment" to someone because of their gender or sexual orientation.

There's no excuse for Oregon insurance not covering doctor-prescribed treatments just because it deals with icky body parts. In a state where laws explicitly ban discriminating against employees based on their sexual orientation and gender, the only reason sex changes aren't routinely covered is that insurance companies are three years behind the American Medical Association, which decided in 2008 that gender identity disorder is a disorder like any other and should definitely be covered by insurance.